Eczema

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Atopic dermatitis:  also known as atopic or infantile eczema.  - a superficial inflammatory process involving primarily the epidermis, marked early by redness, itching, minute papules and vesicles, weeping, oozing, and crusting, and later by scaling, lichenification and often pigmentation.

Atopic dermatitis refers to a chronic inflammatory response of the skin.  It's frequently associated with other atopic diseases, such as bronchial asthma, allergic rhinitis, and chronic urticaria.

Atopic dermatitis usually develops in infants between ages 1 year, commonly in those with strong family histories of atopic disease.  These children often acquire other atopic disorders as they grow older.  Usually, dermatitis subsides spontaneously by age 3 and stays in remission until prepuberty - ages 10 to 12, when it frequently flares up again.

Cause:  There are several theories to attempt to explain its pathogenesis (true caused is unknown).  One theory suggests an underlying metabolically or biochemically induced skin disorder genetically linked to elevated serum IgE levels.  Another suggests defective T-cell function.

Exacerbating factors of atopic dermatitis include irritants, infections, and some allergens, including pollen, wool, silk, fur, ointments, and eggs.  Flare-ups may occur in response to extremes in temperature and humidity, sweating, and stress.

Symptoms:

Intensely pruitic (itching), redness, often excoriated, maculopapular rash, usually on the face and antecubital and popliteal areas.

May have oozing, crusting, and later by scaling, lichenification (thickening and hardening of the skin) and often pigmentation.

Treatment:

Effective measures against atopic lesions include eliminating allergens and avoiding irritants, extreme temperature changes, and other precipitating factors. 

Topical application of a corticosteroid cream or ointment, especially after bathing, frequently alleviates inflammation.

Between steroid doses, application of petrolatum can help retain moisture.

Systemic cortiosteroid therapy should be used only during extreme exacerbations.

Weak tar preparations and ultraviolet B light therapy are used to increase the thickness of the stratum corneum.

If a bacterial agent has been cultured, the doctor may order and antibiotic.

Patient teaching:  bathe daily by soaking in plain water for 10 to 20 minutes. 

Bathe with a special nonfatty soap and tepid water but to use soap only on areas that need cleaning when bathing is finished.  (soaking cleans most skin surfaces).

Shampoo frequently and apply a topical corticosteroid afterward. 

Keep fingernails short to limit excoriation and secondary infections caused by scratching.

Lubricate skin after a tub bath

Irritants, such as detergents, wool, and emotional stress, exacerbate atopic dermatitis

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